Electrocardiogram (ECG) Signal Processing
(2006)

Signal processing today is performed in the vast majority of systems for ECG analysis and interpretation. The objective of ECG signal processing is manifold and comprises the improvement of measurement accuracy and reproducibility (when compared with manual measurements) and the extraction of information not readily available from the signal through visual assessment. In many situations, the ECG is recorded during ambulatory or strenuous conditions such that the signal is corrupted by different types of noise, sometimes originating from another physiological process of the body. Hence, noise reduction represents another important objective of ECG signal processing; in fact, the waveforms of interest are sometimes so heavily masked by noise that their presence can only be revealed once appropriate signal processing has first been applied. Electrocardiographic signals may be recorded on a long timescale (i.e., several days) for the purpose of identifying intermittently occurring disturbances in the heart rhythm. As a result, the produced ECG recording amounts to huge data sizes that quickly fill up available storage space. Transmission of signals across public telephone networks is another application in which large amounts of data are involved. For both situations, data compression is an essential operation and, consequently, represents yet another objective of ECG signal processing. Signal processing has contributed significantly to a new understanding of the ECG and its dynamic properties as expressed by changes in rhythm and beat morphology. For example, techniques have been developed that characterize oscillations related to the cardiovascular system and reflected by subtle variations in heart rate. The detection of low-level, alternating changes in T wave amplitude is another example of oscillatory behavior that has been established as an indicator of increased risk for sudden, life-threatening arrhythmias. Neither of these two oscillatory signal properties can be perceived by the naked eye from a standard ECG printout. Common to all types of ECG analysis—whether it concerns resting ECG interpretation, stress testing, ambulatory monitoring, or intensive care monitoring—is a basic set of algorithms that condition the signal with respect to different types of noise and artifacts, detect heartbeats, extract basic ECG measurements of wave amplitudes and durations, and compress the data for efficient storage or transmission; the block diagram in Fig. 1 presents this set of signal processing algorithms. Although these algorithms are frequently implemented to operate in sequential order, information on the occurrence time of a heartbeat, as produced by the QRS detector, is sometimes incorporated into the other algorithms to improve performance. The complexity of each algorithm varies from application to application so that, for example, noise filtering performed in ambulatory monitoring is much more sophisticated than that required in resting ECG analysis. Once the information produced by the basic set of algorithms is available, a wide range of ECG applications exist where it is of interest to use signal processing for quantifying heart rhythm and beat morphology properties. The signal processing associated with two such applications—high-resolution ECG and T wave alternans—are briefly described at the end of this article. The interested reader is referred to, for example, Ref. 1, where a detailed description of other ECG applications can be found.